Assessing oral health remotely during COVID-19

Abstract

Background: There has been a growing interest in how to assess oral health remotely; particularly so since the advent of COVID-19. Objectives: This community health project aimed to determine the level of agreement in oral hygiene assessments made from images obtained remotely with (a) ‘the use of plaque disclosing agents’ versus (b) ‘without the use of plaque disclosing agents’; and (c) ‘teeth in occlusion’ versus (d) ‘teeth not in occlusion’. Methods: Standardised frontal photos were obtained from a teledentistry device (Dental Monitoring®) among 47 volunteers (188 images in all). Presence of visible plaque was recorded at three sites (distobuccal, midbuccal and mesiobuccal) per tooth (canine to canine) in both arches. Plaque index (PI) scores and ‘% of teeth with plaque’ (PL) scores were derived. Agreement was assessed in two ways: (i) Effect Size (ES) - the standardised difference of the mean directional difference and (ii) the mean absolute difference. Results: For teeth in occlusion (comparing disclosed versus undisclosed images), the ES of PI scores was 0.86 and 1.43 for PL scores; the absolute difference in PI scores was 0.8 and 38.7% for PL scores. For teeth not in occlusion (comparing disclosed versus undisclosed images), the ES of PI scores was 0.86 and 1.81 for PL scores; the absolute difference in PI scores was 0.7 and 39.9% for PL scores. When disclosing agent was used (comparing teeth in/not in occlusion), the ES of PI scores was 0.17 and 0.28 for PL scores; the absolute difference in PI scores was 0.4 and 14.8% for PL scores. Without using disclosing agent (comparing teeth in/not in occlusion), the ES of PI scores was 0.17 and 0.34 for PL scores; the absolute difference in PI scores was 0.4 and 17.5% for PL scores. Conclusion: There is substantial agreement of oral hygiene assessments made remotely from images obtained with ‘teeth in occlusion’ versus ‘teeth not in occlusion’ but not among images of teeth ‘with the use of disclosing agent’ versus ‘without the use of disclosing agent’. This has implications in informing how to assess oral hygiene remotely.